Magnetic resonance imaging for treatment response evaluation and prognostication of hepatocellular carcinoma after thermal ablation

Abstract

Hepatocellular carcinoma (HCC) accounts for the vast majority of primary liver cancer and constitutes a major global health challenge. Tumor ablation with either radiofrequency ablation (RFA) or microwave ablation (MWA) is recommended as a curative-intent treatment for early-stage HCC. Given the widespread use of thermal ablation in routine clinical practice, accurate evaluation of treatment response and patient outcomes has become crucial in optimizing individualized management strategies. Noninvasive imaging occupies the central role in the routine management of patients with HCC. Magnetic resonance imaging (MRI) could provide full wealth of information with respect to tumor morphology, hemodynamics, function and metabolism. With accumulation of liver MR imaging data, radiomics analysis has been increasingly applied to capture tumor heterogeneity and provide prognostication by extracting high-throughput quantitative imaging features from digital medical images. Emerging evidence suggests the potential role of several qualitative, quantitative and radiomic MRI features in prediction of treatment response and patient prognosis after ablation of HCC. Understanding the advancements of MRI in the evaluation of ablated HCCs may facilitate optimal patient care and improved outcomes. This review provides an overview of the emerging role of MRI in treatment response evaluation and prognostication of HCC patients undergoing ablation. Clinical relevance statement MRI-based parameters can help predict treatment response and patient prognosis after HCC ablation and thus guide treatment planning. Key points ECA-MRI provides morphological and hemodynamic assessment of ablated HCC. EOB-MRI provides more information for tumor response prediction after ablation. DWI improve the characterization of HCC and optimize treatment decision. Radiomics analysis enables characterization of tumor heterogeneity guidance of clinical decision-making. Further studies with multiple radiologists and sufficient follow-up period are needed. Graphical abstract

Imaging prognostication and tumor biology in hepatocellular carcinoma

“…Previous studies have shown that patients with tumors demonstrating HBP peritumoral hypointensity had higher recurrence rates after treatment and poorer overall survival than those without peritumoral HBP findings. 58 , 59 Kang et al 60 demonstrated that rate of local tumor progression was higher in patients with HBP peritumoral hypointensity after radiofrequency ablation, likely due to the presence of MVI. 60 , 61 …”

From imaging to clinical outcome: dual-region CT radiomics predicting FOXM1 expression and prognosis in hepatocellular carcinoma

“…Radiomics, a burgeoning non-invasive diagnostic modality, facilitates dynamic tumor monitoring by mining high-dimensional, quantitative metric features from medical images ( 16 – 18 ). Its potential shines especially bright in oncology, given the unique hemodynamic and metabolic signatures tumors exhibit ( 19 ). Recent studies underscore the diagnostic and predictive prowess of radiomics, especially when analyzing both tumoral and peritumoral regions in HCC, offering insights into the tumor microenvironment ( 18 , 20 , 21 ).…”

Dual-region-based computed tomography radiomics analysis for the non-invasive prediction of telomerase reverse transcriptase status and clinical prognosis in liver cancer

“…Radiomics is a high-throughput "image sequencing" process that derives massive imaging parameters for non-invasive, dynamic detection and quantitative response technology to assess tumor characteristics [13]. Radiomics is widely used in clinical practice, and previous studies have shown that it can be used in the early diagnosis of HCC to assess tumor heterogeneity and microenvironment [14,15].…”